Osteoporosis screening, treatment uncommon after stroke

Patients who have had a stroke are infrequently screened and treated for osteoporosis, a recent study found.

Researchers used data from the Ontario Stroke Registry to examine current rates of screening and treatment for bone loss after stroke, which is known to be a predictor of osteoporosis and fractures. Patients at least 65 years of age who were seen in the ED or hospitalized for stroke at 11 regional stroke centers and were alive at discharge were included in the study. Cumulative incidence of screening with bone mineral density testing and treatment with fracture prevention medications within one year after the index stroke was calculated while accounting for competing death risk. The study results were published April 25 by Stroke.

A total of 16,581 patients were included in the study. Of these, 5.1% overall and 2.9% without previous testing were screened for osteoporosis with dual-energy X-ray absorptiometry, and 15.5% overall and 3.2% of those without previous treatment received prescriptions for fracture prevention within one year of the index stroke. Poststroke osteoporosis screening was more common in younger patients, women, and those who had low-trauma fractures after their stroke. Fracture prevention prescriptions were more common in women, those who had osteoporosis before their stroke, and those who fell or had a fracture after their stroke. No association was seen between stroke severity or comorbid conditions and poststroke osteoporosis screening or treatment.

The authors noted that they did not know why individual patients were not screened or treated for osteoporosis and that their results may not be generalizable to patients with different health care coverage, among other limitations. However, they said that the low rates of screening and treatment for osteoporosis in their study represent “a major missed opportunity” to prevent fractures in a group at higher risk. “Future work should focus on the identification of patients at high risk and the development of interventions to improve the quality of osteoporosis care after stroke,” they wrote.